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General NPI Number Information
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NPI Number | 1497168397
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Entity Type | Organization
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Legal Business Name | SOUTH CENTRAL MEDICAL SERVICES, P.A.
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 600 AUTUMN RD
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3606
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Country | US
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Telephone | 501-448-2342
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Fax | 501-221-0615
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Provider Business Mailing Address
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Address Line | PO BOX 11020
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City | FORT SMITH
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State | AR
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Zip | 72917-1020
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Country | US
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Telephone | 479-434-4887
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Fax | 479-434-4955
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | CHESTER L CARLSON
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Credential | D.O.
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Telephone | 479-657-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | E5307
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License Number State | AR
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